Radiographic and clinical outcomes of distal tibia fractures (3-12 cm proximal to the plafond): Comparison of two intramedullary nailing.

BACKGROUND: There are various distal locking options for the repair of tibia distal diametaphyseal fractures with intramedullary nails. There is no consensus about the superiority of any of these distal locking options. In our study, comparing nails with distal bolt locking screw (DSBLS) and conventional nails; we aimed to compare the clinical and radiological results of intramedullary nail models in fixing tibial distal diametaphyseal fractures. METHODS: In our orthopedics and traumatology department, 117 tibial distal diametaphyseal fractures of 116 patients treated with intramedullary nails between August 2007 and May 2015 were retrospectively evaluated. Forty-six tibial distal diametaphyseal fractures of 45 patients who came to regular visits to outpatient clinic controls and who had a minimum follow-up of 18 months and whose fracture distance was between 3 and 12 cm were included in the study. The average follow-up period of the study group consisting of 28 males and 17 females with an average age of 44 (16-76 years) which was 48 months (18-100 months). The group using the DSBLS locking intramedullary nail was considered the first group and the group using the conventional distal locking intramedullary nail was considered the second group. Radiological union times, coronal, sagittal, and axial plan angulations and malunion presence were com-pared between the two groups. In addition, the two groups were compared clinically with length of time spent on weight-bearing and return to work, Olerud-Molander ankle score, and American Orthopedic Foot and Ankle Society Score scores. RESULTS: We found that the first group was superior in terms of length of time spent on partial and full weight-bearing between the two groups (p=0.00031 and p=0.00007). In addition, the union time of the first group was shorter (p=0.0149). Other radiological or clinical results did not differ significantly between the two groups. In addition, no significant correlation was found between the distance of the fracture from the tibial plate and its angulation. In cases with malunion alone, the fracture line was more distal than those without malunion (p=0.0411). CONCLUSION: Newly developed DSBLS intramedullary nails give as good results as conventional nails in tibia distal diametaphyseal fractures. Due to its ability to loading bone early and have a shorter union time, DSBLS can be safely preferred in distal diametaphyseal fractures and reduce complications from immobilization.

Comparison of Self-adhesive Taping and Short-Leg Casting to Treat Tuberosity Fractures of the Proximal Fifth Metatarsal: A Prospective Study.

BACKGROUND: The aim of this study is to compare clinical and radiologic outcomes of self-adhesive taping (SAT) or a short- leg cast (SLC) groups with base of fifth metatarsi. METHODS: Functional outcome was assessed by the Visual-Analogue-Scale Foot and Ankle (VAS-FA) at the Emergency and at 2, 4, 6, and 12 weeks. Labour loss, bone union and The American Orthopedic Foot and Ankle Score (AOFAS) at 12 weeks were also assessed. RESULTS: There was no difference between the SAT group and SLC group in VAS-FA scores at time of injury, 6 and 12 weeks. The SAT group had a significantly higher mean VAS-FA score at the second and fourth weeks of follow-up compared with the SLC group (P = .001 and P = .039, respectively). No correlation was observed between the fracture gap and functional scores for both groups. There was no difference in AOFAS between two groups at 12 weeks. Twenty one patients were unable to work for a mean of 38.2 days during the treatment. 10 patients with the SAT missed 37.5 days and eleven patients with the SLC g missed 40.2 (p: 0.41). The bone union was also achieved for all patients within 12 weeks. CONCLUSION: Treatment with SAT in these fractures had satisfactory functional results compared with traditional SLC. Although there were no significant differences in labor loss and use of assistive devices, The VAS-FA score was significantly higher in SAT group than the SLC group at the second and fourth weeks of treatment.

Extruded disc herniations are experienced earlier by inactive young people in the high-tech gaming era.

In this study, we would like to draw attention to the advanced disc diseases seen in young people. The objective is to investigate the reasons for the increasing trend of disc herniations in young people. A total of 33 young patients with extruded lumbar disc herniations managed by conservative or surgical approaches between 2017 and 2018 were included. The average patient age was 25 years. Smoking, familial predisposition, sporting activity, and the occupation of the patients were questioned and noted. A visual analog scale (VAS) was used to assess the efficacy of pain. Body mass index (BMI) was calculated. All patients were subjected to lumbar magnetic resonance imaging. Eighteen patients (8 females, 10 males) had disc extrusion at the L5-S1 level, whereas 12 patients (8 females, 4 males) had disc extrusion at the L4-L5 level. Three other patients had disc extrusion at the level of both L4-L5 and L5-S1 levels. Motor deficits were detected in four patients, and surgical treatment was required and performed. The other 29 patients were treated conservatively. Young non-sport-oriented patients may face severe disc herniations. Understanding how spine degeneration can affect the likelihood of developing a herniated disc can help people make small lifestyle changes to postpone any serious pain and deficits. While aging is unavoidable, simple lifestyle changes can help improve overall spine health and deter the risk of developing a degenerative spine condition.

Is tranexamic acid safe and reliable during tibial intramedullary nailing?

BACKGROUND: The aim of this study was to determine if the use of tranexamic acid (TXA) during intramedullary reaming treatment for tibial diaphyseal fractures was safe, reduced blood loss, or affected cost effectiveness. METHODS: A total of 70 patients with a tibia diaphysis fracture were randomized into 2 groups and prospectively followed for data on blood loss, thrombosis, and fracture healing. Preoperative TXA was administered intravenously to Group A, and Group B served as the control group. RESULTS: While there was no significant difference between the preoperative and postoperative 1-hour hemoglobin (Hb) and hematocrit (Hct) levels of the patients, there was a statistically significant difference in the comparison of the postoperative 24-hour and 48-hour Hb and Hct levels. There was no need for an allogenic blood transfusion to any patient in Group A; however, 2 patients in Group B each received 1 unit of erythrocyte suspension because their Hct values dropped below 27%. There was no deep vein thrombosis or embolism observed in any of the patients. CONCLUSION: The application of intravenous TXA during the preoperative period in the treatment of tibial fractures with intramedullary nailing reduced the bleeding seen in the postoperative period. It did not lead to intravascular thrombosis in the postoperative period, and had no adverse effect on bone healing.